Biomedical subjects
Publications and source records attributed to H W Baker.
We report a case of liposarcoma of the parotid gland. The tumor was initially controlled with radiation therapy, surgery, and chemotherapy, but the patient died in 24 months with widespread metastatic disease.
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Seven patients with benign and malignant head and neck lesions underwent reconstruction with free jejunal grafts using microvascular techniques. Benefits included preservation and maximal tongue function, acceptable cosmetic appearance and a short, one-stage reconstructive period.
This study evaluates the data of noninvasive (in situ) lobular (ISLC) and ductal (ISDC) carcinoma, collected from 498 hospitals in a National Breast Cancer Survey, carried out by the American College of Surgeons in 1978. ISLC and ISDC were identified in 323 (3.2%) of 10,054 female patients with lobular and ductal carcinoma, of the total of 23,972 patients with histologically proven breast cancer surveyed (1.4%). The frequency of ISLC was significantly higher (18.5%) than ISDC (2.1%) suggesting a less agressive nature of ISLC, with a slower progression to invasion than ISDC. There was a different age distribution of ISLC and ISDC: about 80% of ISLC and 50% of ISDC were diagnosed in patients who were less than 54 years old, and the incidence showed a marked decrease in the older age groups in ISLC, whereas the incidence remained high in the following decade in ISDC. In this series there was a distinctly better five-year cure rate in the patients with ISLC (83.5%) than in the patients with ISDC (68.8%), in spite of the fact that radical surgery was performed more frequently in ISDC (67.8%) than ISLC (36.3%). The recurrence rate was five times higher (10.5%) in ISDC than in ISLC (2.5%). In black patients the recurrence rate (21.3%) was significantly higher in ISDC than in white patients (9.3%). In the present study there were no statistically significant differences in the five-year cure and recurrence rate in patients with noninvasive carcinoma, treated by more conservative procedures (72.9% and 8.5%) and those treated by more extensive surgeries (76.2% and 7.7%). The results of this study suggests that the biologic behavior of ISLC and ISDC may be different with regard to their propensity to invade and their overall prognosis. In contrast, the infiltrative form of lobular and ductal carcinoma, were found to have the same prognosis, regardless of the type of operative procedure performed.
Bromocriptine, 2.5 mg twice daily, was given for 3-4 months to 27 men with poor semen quality. Serum prolactin levels were suppressed. Minor side effects occurred in over half the subjects. Sperm concentration, motility and morphology and FSH, LH, testosterone and dehydroepiandrosterone sulphate levels were not changed significantly. Results for 7 men with 1 or more pretreatment prolactin levels above the upper limit of the normal range, but without other evidence of pituitary disease, were no different from those for the normoprolactinaemic men. It is concluded that bromocriptine is not useful for treatment of infertile men with normal or slightly elevated prolactin levels.
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As part of the national survey on the tumorigenesis of oral contraceptive drugs conducted by the American College of Surgeons' Commission on Cancer, a histologic study was made of 94 cases of liver tumors in users and non-users of oral contraceptives. Pathologic criteria were established and then the slides were studied; the results were tabulated to determine the significance of each of the criteria as related to the use of contraceptives. These criteria included tumor size, peliosis hepatis, hemorrhage, necrosis, fibrosis, thrombosis, and vascular alterations of the intima and media. Cases of focal nodular hyperplasia in pill users exhibited greater vascular alterations, fibrosis, peliosis, and tumor size as compared to focal nodular hyperplasia observed in non-pill users. In addition, hemorrhage, necrosis, and peliosis were much more common in hepatic cell adenoma than in focal nodular hyperplasia. In the material reported in this series there were no hepatic cell adenoma cases observed in non-pill users. Focal nodular hyperplasia cases exhibited an overwhelmingly greater degree of vascular intimal and medial alterations than hepatic cell adenoma. The results suggest that the effects of oral contraceptives on the liver may be primarily upon the vasculature.
A bioassay for inhibin based on the suppression of gonadotrophin releasing hormone (Gn-RH)-stimulated secretion of FSH by primary monolayer cultures of rat anterior pituitary cells is described. The cultures were exposed to standard or test materials for 3 days. The levels of FSH in the media were measured by radioimmunoassay after exposure for 6 h to a maximally stimulating concentration of Gn-RH (10 nmol/l). The standard was prepared from ovine testicular lymph. Several preparations of proteins from gonadal tissues or secretions suppressed the levels of FSH in parallel with the standard. The levels of LH were also reduced but higher doses of active material were required. Non-specificity from cell damage and inactivation of Gn-RH have been excluded. The secretion of gonadotrophins by the pituitary cells was also inhibited by androgens, but not in parallel with the standard and secretion of LH was affected more than that of FSH. Control lymph protein preparations from castrated sheep had no detectable activity. The assay was sensitive and had adequate precision and practicability. It has proved useful for monitoring preliminary steps in the purification of inhibin.
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A clinical trial of danazol was undertaken in 30 patients with severe fibrocystic disease of the breasts. Twenty-three of the patients continued the drug for five or six months to allow adequate evaluation. Partial or complete relief of breast pain, tenderness, and nodularity occurred in all patients studied. One previously unsuspected carcinoma of the breast was discovered after three months of therapy. Side effects from the drug were generally mild. Recurrence of symptoms and physical findings occurred in most patients after the drug was discontinued but have not been as severe as prior to therapy.
To determine if preoperative irradiation should be abandoned in favor of post-hysterectomy irradiation, 65 cases of stage I endometrial carcinomas were analyzed. When no residual tumor or no myometrial invasion was found in the irradiated uterus (38 cases), a 5-year cure rate of 97.3% was obtained. When residual tumor or myometrial invasion was found, there was a 5-year cure rate of 100% in grades 1 and 2 (7 cases) but only a 20% cure rate in grade 3 lesions (5 cases). On the basis of these data there appears to be no reason to abandon preoperative irradiation in stage 1 cases. More extensive irradiation and surgery should be considered, however, in grade 3 lesions invading the myometrium.
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Survey results of long- and short-term outcome audits of colon cancer in participating hospitals with cancer programs conducted during 1976-7 by the American College of Surgeons are presented. In the long-term audit of 38,621 cases reported by 327 hospitals in 46 states, the overall percentage of cases in localized stage (29.3%) is significantly lower than in the recent series from the National Cancer Institute. The observed survival was substantially lower than the survival rates published in recent smaller series; however, survival approaches the end results for the period 1967-1973. In the short-term audit, the analysis of 11,655 cases diagnosed in 1976 and reported by 491 hospitals from fifty states showed that while 41% of patients had symptoms for less than a month, only 29.5% were diagnosed in the localized stage. Surgery was the predominant treatment modality with an overall resectable rate of 83%. No difference was observed in the stage at diagnosis when the short-term audit (1976) was compared with that found in the long-term audit (1971). The results suggest that the early diagnosis of symptomatic patients may not always substantially improve the cure and survival rate. The screening of asymptomatic patients is suggested as the more promising approach to the substantial improvement of presently less than ideal end results.
Medium from cultures of mature rat seminiferous tubules contained a substance which suppressed, in a dose-related manner, the luteinizing hormone releasing hormone (LH-RH)-stimulated secretion of FSH by cultured rat pituitary cells. The secretion of LH was suppressed to a lesser extent and the basal secretion of both LH and FSH was inconsistently affected. Gel filtration on Sephadex G-100 did not fractionate the activity. The active material did not inhibit the secretion of TSH or destroy LH-RH and the activity was not due to testosterone or oestradiol in the medium. Control media from liver cultures were inactive. It is concluded that inhibin is present in media from cultures of rat seminiferous tubules.
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Data on 378 (in females) and 165 (in males) cases of primary liver tumors reported by 477 hospitals in the United States during 1970 to 1975 show that in males, 91.5% of the tumors were malignant, and in females, 43.9% were malignant and 59.1% were benign. Of the 212 benign tumors in females, 96 were hepatic cell adenomas and 58 were focal nodular hyperplasias. A history of oral contraceptive use was found in nearly half of all women: 65% with benign tumors, 74% with hepatic cell adenomas, and 74% with focal nodular hyperplasias. Symptoms were more severe among users. No case of intraperitoneal bleeding was observed in nonusers. The findings confirm the suggested association between oral contraceptive use and hepatic cell adenomas and focal nodular hyperplasias.
Rat testes and accessory sex organs were perfused in situ by recirculating an artificial medium through the hemicorpus preparation previously developed for studies of skeletal muscle. The advantages and limitations of this system for studying the male productive tract were examined. The electrolyte and gas composition of the perfusate remained constant and glucose levels did not fall below normal during 3 h of perfusion. Testicular water content, temperature, and ATP and GTP levels were normal at 90 min. The mean arterial pressure was 40 mm Hg and the flow rates, measured with microspheres, were normal to high to the caput epididymides, ventral prostate and seminal vesicles and approximately half normal to the testes in preparations from 90 day old rats perfused at 35 ml/min. Administration of vasodilators indicated the absence of significant vasoconstriction in the hemicorpus. There was appreciable testosterone metabolism by the preparation and in addition, there was absorption of testosterone by the plastic tubing of the perfusion apparatus. Testosterone levels in the perfusate rose for 90 min in response to hCG. There was a dose-response relationship between hCG (20-1000 mIU/ml of medium) and testosterone levels at 90 min. FSH, prolactin, insulin and vitamins had no significant effect on hCG-stimulated testosterone levels. This perfusion system should prove useful for studies of hormone action.